title: The cost-effectiveness of supervised exercise for the treatment of intermittent claudication.
abstract: BACKGROUND
  Supervised exercise (SE) is thought to result in improvements in walking distance and quality of life compared with unsupervised exercise (USE) in people with intermittent claudication. However, the cost-effectiveness of SE is unclear. As a result, many patients are currently unable to access supervised programmes.
  
  
  METHODS
  We searched MEDLINE, Embase, Cochrane, and Cinahl databases to identify randomised controlled trials comparing USE with SE in adults with intermittent claudication. A Markov model was developed to estimate costs and quality adjusted life years (QALYs) from an NHS and personal social services perspective. Quality of life was obtained from the included clinical trials. Resource use was modelled on current programmes and unit costs were based on published sources.
  
  
  RESULTS
  Depending on estimated rates of compliance, SE was cost-effective in over 75% of model simulations, with an incremental cost-effectiveness ratio of £711 to £1,608 per QALY gained. The model was sensitive to long-term effects of exercise on cardiovascular risk and quality of life.
  
  
  CONCLUSIONS
  SE is more cost-effective than USE for the treatment of people with intermittent claudication. Supervised programmes should be made widely available and offered as a first line treatment to people with intermittent claudication.
authors.affiliation: Royal College of Physicians, National Clinical Guideline Centre, London, UK. Electronic address: s.l.bermingham@gmail.com.
authors.forename: S L
authors.initials: SL
authors.lastname: Bermingham
authors.forename: K
authors.initials: K
authors.lastname: Sparrow
authors.forename: R
authors.initials: R
authors.lastname: Mullis
authors.forename: M
authors.initials: M
authors.lastname: Fox
authors.forename: C
authors.initials: C
authors.lastname: Shearman
authors.forename: A
authors.initials: A
authors.lastname: Bradbury
authors.forename: J
authors.initials: J
authors.lastname: Michaels
mesh_terms: D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D023801:Directly Observed Therapy / Q000191:economics*; D005081:Exercise Therapy / Q000191:economics*; D017079:Exercise Tolerance; D006801:Humans; D007383:Intermittent Claudication / Q000628:therapy*; D011788:Quality of Life; D016138:Walking
keywords: Cardiovascular disease; Cost-effectiveness analysis; Exercise; Peripheral artery disease; Systematic review